When Sex Is Painful…For People With Penises and Testicles

If you have had the experience of anticipating the satisfying release of an orgasm, only to be surprised by pain instead, you are not alone. Painful erections, ejaculation, and pain following sex are often symptoms of pelvic floor tension and/or pudendal nerve issues. How does this happen?

Pelvic floor tension during sex and pudendal nerve pain is usually a result of one or a number of the following factors…

• Injury to the pelvis, testicles, penis, hips, or back

• Infection (UTI, STI, prostatitis)

• Abdominal, back, or pelvic surgeries

• Hernias

• Chronic sitting, suboptimal posture and movement patterns

• Activities that put pressure on the pelvic floor such as bike riding, squatting, and heavy weight lifting

• Diet

• Stress and anxiety

• Sexual context - does it feel safe, is it pleasurable, is there anxiety associated with it?

• History of trauma

So now what? First it is important to identify the potential contributing factors. As a pelvic floor PT, I do this by getting a thorough medical history including relevant psychological and relationship information and then doing a physical exam of the pelvic floor muscles and facia connected to the pelvis, testing sensation, and looking at skeletal alignment, core tension and strength, and posture. Once the root of the pain is determined, you and your provider(s) can figure out the best treatment options which may include manual muscle release, dry needling, stretching, strengthening, and breathing exercises, lifestyle and diet modifications, posture and ergonomic adjustments, sensation focused solo and partnered activities, sex counseling or therapy, and stress management strategies. Once the pain is gone, you can focus on rebuilding your capacity for pleasureful and satisfying sexual experiences again!